Allison is a classic case of the dangers of polypharmacy. She came to Whitaker Wellness because her knee pain, urinary incontinence, heartburn, constipation, weight gain, insomnia, weakness in her legs, fatigue, and forgetfulness were getting worse, and all her doctors in Phoenix did was prescribe more and more drugs.
We ordered blood tests, did a physical exam, reviewed her medical records, and determined that she was quite healthy for a 75 year old. Her most significant problem, which was causing most of her symptoms, was not a disease but her medication load. Allison was taking eight prescription and four over-the-counter drugs daily, plus five more meds on an as-needed basis. Allison was a true victim of polypharmacy: “multiple, excessive, unnecessary, or unindicated drug consumption.”
Polypharmacy = Inappropriate, Excessive Medications
Polypharmacy is a serious and increasingly common problem that makes patients sitting ducks for adverse side effects and dangerous drug interactions, raises risk of hospitalization and death, and drives up healthcare costs.
People of all ages get stuck on the drug merry-go-round, but polypharmacy is especially common in older people, who are likely to have numerous medical issues, see several physicians, and receive multiple prescriptions. Unfortunately, it’s not unusual for patients to arrive at Whitaker Wellness on 10 or more medications! A recent study revealed that 36 percent of Americans ages 62-85 are on five or more prescription drugs—many of them inappropriate for their age group—and 15 percent take drug combos that place them at risk of major drug-drug interactions.
Allison is a case in point. One of her meds was Ambien, a “hyponotic sedative” sleeping pill. Because Ambien’s side effects include next-day drowsiness, impaired alertness and cognitive function, and increased risk of falls and accidents, it is listed on the American Geriatrics Society’s list of potentially inappropriate medications for seniors. Yet it accounts for 21 percent of ER visits for adverse psychiatric drug reactions in people over age 65.
She also occasionally took Sominex to help her sleep. Diphenhydramine, the active ingredient in Sominex, Benadryl, and dozens of other over-the-counter antihistamines and sleep aids, belongs to a class of drugs called anticholinergics that are also inappropriate for older people. Side effects include constipation, sleepiness, confusion, and increased risk of dementia with longtime use. No wonder Allison was tired and forgetful!
Polypharmacy Leads to Prescribing Cascades
Another danger of polypharmacy is that is also increases the likelihood of prescribing cascades, which result when adverse drug side effects are mistaken for new medical problems and more drugs are prescribed for these additional “conditions.” Again, Allison fits the bill.
For her knee pain, she was taking a prescription nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are notorious for their gastrointestinal (GI) toxicity, especially in older people. Sure enough, Allison ended up with serious heartburn, so her doctor had her take Prilosec, a proton pump inhibitor that protects the GI tract but increases risk of bone loss and C. difficile infection.
She had also been prescribed Aricept, a drug that may help slow memory loss but has numerous side effects, including urinary incontinence. Not surprisingly, her incontinence worsened, so she was started on Enablex, another anticholinergic drug that is associated with constipation and cognitive impairment.
In other words, this patient was prescribed drugs to treat drug-induced problems (heartburn and urinary incontinence) that worsened her original problems (incontinence and forgetfulness)!
“Deprescribing” to Cure Polypharmacy
The first thing I did for Allison was get busy “deprescribing”—tapering or stopping her unnecessary drugs. I discontinued her sleeping pills, diagnosed her with sleep apnea, and ordered APAP (automatic positive airway pressure) to keep her airways open during sleep.
We treated her arthritic knees with platelet-rich plasma and laser therapy and started her on glucosamine, fish oil, and curcumin to help rebuild cartilage and relieve inflammation. She went through our Back to Health Program, cleaned up her diet, and began exercising.
Guess what? Now that she was getting deep, restful sleep, she felt so much more energetic and clearheaded that she discontinued her “memory pills.” Over the next month, her urinary incontinence and constipation improved and she stopped the meds she had been taking for those conditions as well. As her knee pain improved and she weaned herself off NSAIDs, her heartburn cleared up and she discontinued Prilosec.
We also stopped the statin drug Allison had been prescribed, even though her total cholesterol had never been above 186 and she had no history of heart problems. (Current guidelines recommend statins for 77 percent people over age 60, even though these drugs are linked with memory loss, muscle pain, risk of diabetes, and more.) Finally, we changed her Synthroid to natural thyroid. Her leg pain improved, and she began losing weight.
Bottom line, we cured Allison’s primary problem—polypharmacy—by discontinuing the bulk of her medications. As a result, most of her symptoms subsided and her quality of life dramatically improved.
Polypharmacy: Serious Problem, Simple Solution
Medication side effects are far more common than you might suspect, and as bad as Allison’s were, they can be much more serious. Adverse reactions to properly prescribed drugs result in 1.9 million hospitalizations every year, and another 840,000 patients experience life-threatening adverse medication events while in the hospital. All told, prescription drugs are responsible for 128,000 deaths per year, making this America’s fourth leading cause of death.
Polypharmacy obviously plays a central role in this colossal failure of conventional medicine. But there is a solution.
We need to start thinking beyond medications. As Allison’s story demonstrates, there are many helpful, even curative non-drug interventions. Other examples include EECP, which dramatically reduces angina and medication requirements in patients with heart disease. Weight loss and lifestyle changes lower blood sugar and allow patients to get off insulin and oral diabetes drugs. PRP, prolotherapy, laser, acupuncture, and other pain-relieving treatments reduce or eliminate reliance on painkillers. And targeted nutritional supplements can replace a whole slew of medications.
Patients need to step up and take charge of their health—even if means second guessing doctors’ recommendations. As Allison said, “One thing I learned at Whitaker Wellness was that I am in charge. I used to be afraid to question my doctors’ orders because I assumed they knew what they were doing. Now I know that isn’t always true. My healthcare is my responsibility and mine alone.”
Sidestepping the Dangers of Polypharmacy
Here’s a cheat sheet that can help you avoid the dangers of polypharmacy.
- Keep a current list of all your medications, doses, potential side effects, and reasons for taking them and review it periodically with your primary care physician.
- Question the necessity and safety of any new drug order and ask about non-drug alternatives. Assume any symptoms that begin after adding a new drug are side effects of those meds and discuss with your doctor.
- If you need help getting a handle on polypharmacy, consider coming to Whitaker Wellness. Call 866-944-8253 or fill out this form to be contacted by one of our friendly and knowledgeable Patient Services Representatives.